The truth about tennis elbow

Tennis elbow is a condition that can affect more than those people who play tennis – and if anything, it’s become less common in tennis over the years. With advances in racquet technology and improvements in technique, the incidence within players has clearly reduced. In the clinic we see a lot more people present with tennis elbow as a result of repetitive strain from the use of a computer, or from their work in a manual occupation (such as electricians, gardeners or carpenters).

It is not uncommon to see tennis elbow occur in other sports too. Golf is a common example as it involves a lot of gripping and an action that is quite repetitive. Gym-goers are not exempt either, especially if there has been a change in their weights program.

What IS tennis elbow?
Tennis elbow is somewhat of an umbrella term for a few different conditions that can occur around the lateral (or outside) part of the elbow. The technical name for it is Lateral Elbow Tendinopathy as it refers to a degeneration of the tendon that connects the muscles of the top part of the forearm (the extensor muscles that lift the wrist up and down) to the elbow.

Until recently, it was termed a tendonitis, referring to an inflammation of the tendon but recent research suggests it is more of a breakdown of the tendon that occurs with excessive strain. The injury is more common in people over the age of 35, often as a result of accumulated load over many years.

Prime candidates
Elbow problems for pros will usually only exist if they have been making changes to their grip or playing around with different racquets or strings. The switch to clay can also be challenging, as this surface lends itself to longer rallies therefore an increase in the load on their tendons.

The social player is more likely to suffer from tennis elbow if they play sporadically or have a sudden spike in the frequency of their tennis. Technique can also be a problem at this level – a common mistake is dropping the wrist into too much flexion during the backhand, which puts the forearm muscles into an overly strained position.

Associated injuries
Any injury can lead to other injuries or problems due to changes in movement patterns and compensations we consciously and subconsciously make to try and alleviate the problem.

For tennis elbow it can occur in conjunction with other upper limb overuse injuries, such as rotator cuff (shoulder) injuries, wrist tendon and ligament injuries. The reverse can also be true in that a shoulder or wrist injury could lead to tennis elbow.

Prevention and cure
Given that it’s an overuse injury be conscious of changes in your load – that is, the frequency and length of match play and training; alterations to technique or equipment, as well as what’s occurring in your life off court.

Always aim to make any changes incrementally over several weeks and allow a little more recovery time than you would normally, adding an extra day of rest between harder sessions. The off days might be more leg or movement focused to reduce strain on your arms.

Ensure there are no weak spots in the kinetic chain – keep the rotator cuff and shoulder blade stabiliser muscles strong to give the elbow something nice and strong to attach to. This should have both elements of lower intensity endurance, as well as high intensity ballistic movement to improve tolerance to elastic loading during explosive muscular contractions.

If you work at a desk get an ergonomic assessment, where possible, to minimise the risk of this contributing to the development of tennis elbow. If you work in a manual job be conscious of how much gripping or lifting you do off the court. If there is a hint of fatigue in the upper limb muscles from a hard days’ work, then perhaps consider making that day’s tennis session less racquet focused and work on aspects such as fitness, footwork and speed.

Rehabilitation exercises will be a central component of treatment as this has most consistently shown results in research. In patients with chronic tennis elbow, one study showed exercise leads to a faster and greater regression of pain, less sick leave and fewer medical consultations.

The general principles will be to first reduce the pain – this could involve the use of medication, reduction in load on the tendon, avoiding the aggravating activities, taping, or hands-on treatment. Then a progressive strengthening program is required to improve the tendon’s ability to withstand the forces applied on it through tennis, this would normally involve some eccentric exercises which focus on the tendon’s capacity to stretch under load – for example hanging the wrist off the side of a table with the palm facing down and slowly lowering the wrist with a weight.

Pro perspective
When pain is intruding on your life – making it difficult to continue playing or training at your preferred level, or even affecting your ability to work effectively – it’s time to seek advice from a sports medicine professional, whether that be a doctor, physiotherapist, osteopath or chiropractor. Also consult a coach, as there may be something simple with their technique that might need addressing. There could be a chance to give tennis elbow the elbow before you’re even aware that it exists!

Rob Brandham, APA Sports Physio, BPhysio, MPhysio (Sports), has experience managing musculoskeletal injuries in AFL, soccer and rugby. He has worked at the Australian Open and Tennis Australia. Rob is based at the St Kilda Road Sports and Physiotherapy Centre.